Two autopsies on rhodesiense sleeping sickness; Visceral lesions and significance of changes in cerebrospinal fluid

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Abstract
Two autopsies are described of cases of rhodesiense sleeping-sickness, in which no appreciable treatment had been received. There were extensive trypanosomal effusions in the pleural, peritoneal and pericardial cavities, and marked inflammation of the myocardium, epicardium and endocardium. These visceral lesions were closely similar to those described by Peruzzi in the trypanosomiasis of monkeys. The cerebrospinal fluids of these cases contained numerous trypanosomes but the cell-count and protein content were not much raised; corresponding to this pathological pattern in the fluid, the histological lesions in the central nervous system were very slight, being limited to a histiocytic infiltration of the cerebral membranes. From these cases and from experiments in vitro, it is concluded that it is not possible to have a true invasion of the cerebrospinal fluid by trypanosomes until the protein content is considerably increased. In the absence of treatment, the visceral lesions of rhodesiense sleeping-sickness are probably more often fatal than the lesions of the nervous system. These two cases also suffered from widespread infection with tuberculosis.

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